New York - NY State to Participate in Pre-Existing Condition Insurance Plan

New York - Governor David A. Paterson today announced that New York State has applied to develop a program so that uninsured New Yorkers will be able to benefit from the temporary pre-existing condition insurance funding made available in the Federal health care reform statute, the Patient Protection and Affordable Care Act.

“One of the most immediate benefits of Federal health reform is this program to provide assistance to people with health problems and no insurance,” Governor Paterson said. “We welcome this opportunity to help our most vulnerable uninsured New Yorkers and we look forward to working with the Federal government to implement this program as quickly and effectively as possible.”

The Federal statute makes $5 billion available over the next three and a half years, of which New York is expected to receive about $297 million. The Federal government has guaranteed that no financial responsibility for this program will be shifted to the states. The program will provide health insurance coverage to eligible individuals who are uninsured and have pre-existing health conditions. The program will begin in 2010 and will last until more comprehensive coverage options become available through a Health Insurance Exchange in 2014. States have the option of designing their own programs or leaving implementation of a program to the U.S. Department of Health and Human Services (HHS).

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New York State Insurance Superintendent James J. Wrynn said: “I applaud Governor Paterson for his efforts to ensure that New York receives these funds to better serve those who need medical assistance the most. It is important for New York to design its own program because of the unique characteristic of our community rated, guaranteed issue insurance marketplace, which provides New Yorkers with access to health insurance without regard to their age, sex, health status or occupation. New York wants to ensure that the new program includes our important and hard fought consumer protections.”

New York has requested that Group Health Incorporated (GHI) serve as the designated nonprofit contractor to operate a qualified high risk pool on behalf of the State. By Federal rules, only a nonprofit can serve in this role. GHI is a subsidiary of Emblem Health and is the only nonprofit company authorized to operate statewide in New York State. GHI’s statewide network of participating providers will make it easier to facilitate access for care for New Yorkers all around the State.

In designing the proposed program, the State Insurance Department consulted with a broad range of stakeholders, including consumers, businesses, providers and insurers. The goal was to create an affordable program that also offered comprehensive coverage. To ensure access to needed care, the program will include low co-pays as well as services that will assist enrollees in managing chronic conditions and maintaining overall health. The program is expected to enroll about 15,000 New Yorkers.

The Pre-Existing Condition Insurance Plan is required to cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. The Plan will not base eligibility on income and does not charge a higher premium because of a pre-existing medical condition.

The Federal funds will cover any operational costs and also subsidize premiums, which will be well below the current cost of coverage in the individual market. The State’s goal is to have premiums below $600 a month. The cost of the insurance premiums to individuals and the start date depend on Federal approval. Assuming timely approval of New York’s application, New York hopes to begin accepting applications by August 15, 2010, with coverage available by the late fall.

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Jul 02, 2010 at 08:41 AMCharlie Hall Says:

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GHI pays for practically nothing!! I checked them out. Did the Governor?? What kind of ins. does the Gov. have?? What will GHI pay for?? Not for a doctors's visit ”

That is why we need the full healthcare reform plan! Unfortunately, the right wingers delayed its effectiveness for four years. This interim plan will, however, help those with catastrophic medical bills from being reduced to poverty. Many individuals will benefit and it might also keep some more hospitals from going under.